Lower Leg Fracture – Tibia/Fibula:
May be an angulated fracture with impairment of circulation distal to the site of the fracture.
If angulated the fracture can be easily reduced into proper anatomical alignment with gentle Traction-In-Line (TIL).
Splint the lower leg in proper anatomical alignment with distal pulses intact.
A splint can be easily improvised with an ensolite pad or well-padded sticks held in place with cravats.
Splint with the foot held at 90 degrees.
Monitor circulation every 15 – 30 minutes.
“Ottawa Rules” can be used to help determine if the injury is a fracture or not.
The Ottawa Rules are:
Need to be an adult (i.e. good historian).
1. No tenderness over the malleoli (the lateral and medial aspects of the ankle).
2. No laxicity on inversion, eversion, or drawer test of the ankle.
3. They can walk 3 steps without pain or sensation that the ankle is going to collapse.
If suspicious of a fracture then treat the same way as a tibia/fibula fracture.
If a sprain then RICE the ankle and support with a sprained ankle bandage.
Video demonstration of applying a sprained ankle bandage:
A “March Fracture” is a stress fracture of the 5th metatarsal that is caused by a long march or hike.
Diagnosis – pain and tenderness over the center of the lateral arch of the foot.
Treatment is to support the foot well with a firm boot.
May be angulated, is so apply TIL to straighten, move into proper anatomical position.
Splint the injured to by “buddy taping” the injured toe to the adjacent toe, with padding in between the toes for comfort and support.
Support the fractured toes by wearing a stiff-soled shoe to prevent flexion of the toes.
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